A new survey conducted by the consulting firm The Lewin Group, Falls Church, Va., concludes overcrowding problems in the nation's emergency departments (EDs) are high and getting worse. During the survey period, a majority of EDs were full and often operated at or over capacity, which at times caused a third of hospitals to reroute ambulances to other facilities, according to a study performed on behalf of the AHA.

The survey is based on responses from 1,501 hospitals, representing 36 percent of U.S. facilities with EDs. They were asked to track ED activity during November 2001.

The lack of critical care beds was cited 43 percent of the time as the reason for ambulance diversion, overcrowded emergency rooms was the problem according to 24 percent, and 14 percent attributed it to a lack of general acute care beds. AHA officials say overcrowding and diversion are signs of a bigger problem related to staff shortages, and the survey shows hospitals with higher registered nurse vacancies experienced more frequent diversions. Hospitals that had to reroute ambulances 20 percent or more of the time had a 16 percent RN vacancy rate, and facilities with no diversions had an 11 percent vacancy rate.

The problem is expected to worsen as pressure on hospital EDs grows in the next few years, according to the AHA. In 1990, community hospitals had more than 80 million visits to their EDs, and in 2000, that number reached around 100 million. Figures for 2001 are expected to grow beyond that number and will continue to rise in the future, according to survey estimates.

The complete findings of the survey are available at www.aha.org/info/emergencydeptoverload.asp.

This article first appeared in the May 2002 issue of Materials Management in Health Care